Wednesday, January 23, 2019

Olanzapine May Help Adults With Anorexia Gain Weight

Many patients who take the antipsychotic olanzapine for psychiatric disorders are known to experience significant weight gain. A study in AJP in Advance now suggests that olanzapine may be able to help adults with anorexia gain some weight, but it does not appear to reduce psychological symptoms associated with the disorder.

“We found a weight gain effect associated with olanzapine, but it was more modest than the significant, usually undesirable, weight gain seen when olanzapine is used to treat other disorders,” Evelyn Attia, M.D., of Columbia University Irving Medical Center and colleagues wrote. The findings are “notable, as achieving change in weight is notoriously challenging in this disorder,” they added.

For the study, which was carried out at five North American sites, Attia and colleagues randomly assigned 152 adults aged 18 to 65 with anorexia (96% women; mean body mass index [BMI]: 16.7) to olanzapine or placebo for 16 weeks. Patients were excluded from the trial if they had a general medical or psychiatric condition that required immediate attention; a current diagnosis of substance abuse or dependence, schizophrenia, schizophreniform disorder, or bipolar illness; a neurological problem; or an allergy to olanzapine or a documented failure to respond to or inability to tolerate olanzapine at 10 mg/day. Medication was initiated at 2.5 mg/day for two weeks, then increased to 5 mg/day for two weeks, and up to 10 mg/day for the rest of the trial.

All participants met weekly with a study psychiatrist to discuss symptoms and possible side effects from their assigned treatment. Height and weight were measured at baseline, and weight was measured at each weekly assessment. The researchers used the Yale-Brown Obsessive Compulsive Scale (YBOCS) interview and several other assessments to assess participants’ obsessionality, eating disorder severity, and other factors over the course of the trial.

The researchers found that olanzapine was associated with a significantly greater rate of weight gain than placebo (approximately 1 lb per month for a woman of average height, or 5 feet 5 inches). There was no significant difference between treatment groups in rate of change in YBOCS total score or YBOCS subscale scores.

“[O]ur results suggest that olanzapine may provide a modest therapeutic benefit for adult outpatients with anorexia nervosa, a group much in need of effective treatment strategies. Olanzapine alone clearly does not constitute a sufficient treatment intervention and should be provided in the context of appropriate psychological and behavioral therapy,” Attia and colleagues wrote. “Future studies should examine how best to combine olanzapine with other treatment interventions and assess longer-term outcomes. More broadly, this study underscores the challenges of treating anorexia nervosa and the need for research to improve our understanding of its relative refractoriness to both psychological and pharmacological treatments.”

For related information, see the book Handbook of Assessment and Treatment of Eating Disorders from APA Publishing.

(Image: iStock/FatCamera)

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